(CNN) — China’s sudden and unprepared exit from zero-COVID strategy could result in nearly 1 million deaths, new study finds, as the country braces for an unprecedented wave of infections that would spread from its largest cities to its vast rural areas.
For nearly three years, the Chinese government has used stringent lockdowns, centralized quarantines, mass testing and stringent contact tracing to slow the spread of the virus. That costly strategy was abandoned earlier this month, following an outburst of protests across the country against harsh restrictions that have disrupted business and daily life.
But experts have warned the country is ill-prepared for such a drastic exit, failing to bolster the vaccination rate for the elderly, increase intensive care capacity in hospitals and stockpile antiviral drugs.
Under current conditions, a nationwide reopening could result in up to 684 deaths per million people, according to projections by three University of Hong Kong professors.
Given that China’s population is 1.4 billion people, this would equate to 964,400 deaths.
The rise in infections “will likely overburden many local health systems across the country,” says the research paper, which was posted last week on Medrxiv’s preprint server and has not yet been peer-reviewed.
The simultaneous lifting of restrictions in all provinces would generate hospitalization requests of 1.5 to 2.5 times the maximum hospital capacity, according to the study.
But this worst-case scenario could be avoided if China quickly rolls out booster vaccinations and antiviral drugs.
With 85% fourth-dose vaccination coverage and 60% antiviral coverage, the number of deaths can be reduced by 26-35%, according to the study, funded in part by the Chinese Centers for Disease Control and Prevention (CDC) and by the Hong Kong Government.
Chinese health authorities announced two deaths from Covid on Monday, both in the capital Beijing, which is facing its worst outbreak since the start of the pandemic.
They were the first officially reported deaths since the dramatic easing of restrictions on Dec. 7, though posts on Chinese social media have indicated increased demand at Beijing’s funeral homes and crematoria in recent weeks.
An employee of a funeral home on the outskirts of Beijing told CNN that he was overwhelmed by the long cremation lines and that patrons would have to wait at least until the next day to cremate their loved ones.
On Baidu, China’s leading online search engine, searches by Beijing residents for “funerals” have hit a record high since the start of the pandemic.
Other major cities are also facing an increase in infections. In the financial center of Shanghai, schools have moved most of their classes online as of Monday. In the southern metropolis of Guangzhou, authorities have told students already attending online classes and preschoolers not to prepare for returning to school.
By contrast, in the southwestern megacity of Chongqing, authorities announced on Sunday that public sector workers who have tested positive for Covid can go to work “business as usual”, a notable change for a city that just a few weeks ago was been in in the middle of a massive blockade.
It is difficult to judge the true extent of the epidemic from official data. China stopped reporting asymptomatic cases last week and admitted it was no longer able to track the actual number of infections. These asymptomatic cases accounted for the majority of the country’s official cases. But the rest of the case count has lost meaning as well, as cities have scaled back mass testing and allowed people to use antigen testing and isolate themselves at home.
Chinese experts have warned that the worst is yet to come. Wu Zunyou, chief epidemiologist at China’s CDC, said the country was hit by the first of three waves of infections expected this winter.
Speaking at a conference in Beijing on Saturday, Wu said the current wave would last until mid-January. The second wave is expected to last from late January to mid-February next year, triggered by mass travel ahead of the Lunar New Year holiday, which falls on January 21.
Every year, hundreds of millions of people who have left their hometowns to make a living in China’s rapidly growing cities board trains, buses and planes to see family, a multi-week travel rush known as the Greatest Migration annual human on Earth.
For three consecutive years, the authorities have discouraged such travel under the zero covid policy. And experts warn that as domestic travel restrictions are lifted, the virus could spread to rural China, where vaccination rates are lower and medical resources are lacking.
A third wave of cases would run from late February to mid-March, when people return to work after their week off, Wu said.
